THE ASSOCIATION OF FRAILTY AND MORTALITY IN OLDER ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDY

Abstract Frailty is associated with poor health outcomes in later life, improving lifespan and death through different mechanisms. This study aimed to systematically review the epidemiological evidence from cohort studies investigating the association between frailty and all-cause mortality, and to determine if frailty affects mortality in older adults. We searched for studies published and indexed in 4 electronic databases (EMBASE, PubMed, Cochrane Library, and Web of Science) and manual search and identified 28 cohort studies before Dec 31, 2022. We include studies if their design was longitudinal; the exposure of interest was measured frailty; the endpoint of interest was mortality; they provided a risk estimate (i.e., hazard ratio [HR]) and the corresponding 95% CI for the association between frailty and mortality. They used different indexes as their frailty as exposed definitions. Two investigators independently screened the full-text articles for inclusion. We used a random-effects model to obtain pooled HRs. Thirty-one studies were included for qualitative review, of which twenty-eight were eligible for meta-analysis, and included 67,114 individuals from 16 countries. Compared with healthy adults, frail adults had a significantly higher mortality risk. The pooled HR for mortality per increment of 0.1 frailty of community-dwelling adults was 2.33 (95% CI 2.05-2.65; I2 76.9%). The present study demonstrated that frailty was not only significantly related to an increased mortality risk but was also a strong predictor of mortality in community-dwelling adults.

(n=1,037).Brain health was measured when Study members were age 3 using a neurological examination, tests of cognitive functioning, and temperament rating.Physical function was measured at age 45 using gait speed, step-in-place, chair stands, balance, and grip strength tests.Children with worse brain health had significantly worse physical function as adults (β, 0.23; 95% CI, 0.16 to 0.30; P < .001),after controlling for sex and childhood socioeconomic status.This relationship supports a link between cognitive and physical function in the aging and development process, the reconceptualization of aging and development on the same ontological path, and the utility of physical function testswhich can be used in many clinical settings -as reflections of lifelong, integrated health in addition to indicators of musculoskeletal integrity in older adults.Frailty is a clinical condition characterized by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality.In the light of global population aging, the prevalence of frailty is expected to soar in coming decades.The current study provides a review of novel developments and emerging practices in frailty research regarding prevention, identification, and management of the condition in older adults.We searched geriatric journals in the top two quartiles (based on 2021 Impact Factors from Clarivate Journal Citation Reports) for articles published between January 2018 and December 2022.We screened 1519 articles for eligibility and assessed the full text of 278 articles.Popular research trends included the study of frailty transitions and trajectories, analyses of life-course risk factors for frailty, identifying frailty using biomarkers (and biomarker panels), and investigating the altered response to medications by older adults with frailty.Other areas with novel developments included: artificial intelligence (machine learning) for frailty identification; exercise and physical activity for the management of frailty; medication management, gerontechnology; education of healthcare professionals; integrated care; person-centered care; guidelines; cost-effectiveness of management strategies; and COVID-19.This review identified a strong need for the implementation and evaluation of cost-effective and community-based interventions to prevent and manage frailty.Our findings highlight the need to strengthen healthcare systems to better support older adults with frailty and involve those with frailty in shared decision-making regarding their care.
Frailty is associated with poor health outcomes in later life, improving lifespan and death through different mechanisms.This study aimed to systematically review the epidemiological evidence from cohort studies investigating the association between frailty and all-cause mortality, and to determine if frailty affects mortality in older adults.We searched for studies published and indexed in 4 electronic databases (EMBASE, PubMed, Cochrane Library, and Web of Science) and manual search and identified 28 cohort studies before Dec 31, 2022.We include studies if their design was longitudinal; the exposure of interest was measured frailty; the endpoint of interest was mortality; they provided a risk estimate (i.e., hazard ratio [HR]) and the corresponding 95% CI for the association between frailty and mortality.They used different indexes as their frailty as exposed definitions.Two investigators independently screened the full-text articles for inclusion.We used a random-effects model to obtain pooled HRs.Thirty-one studies were included for qualitative review, of which twenty-eight were eligible for meta-analysis, and included 67,114 individuals from 16 countries.Compared with healthy adults, frail adults had a significantly higher mortality risk.The pooled HR for mortality per increment of 0.1 frailty of community-dwelling adults was 2.33 (95% CI 2.05-2.65;I2 76.9%).The present study demonstrated that frailty was not only significantly related to an increased mortality risk but was also a strong predictor of mortality in community-dwelling adults.

THE RELATIONSHIP OF SELF-MONITORING OF LIFESTYLES WITH PHYSICAL FUNCTION AND METABOLITES IN DIABETIC OLDER ADULTS
Yan Du 1 , Lixin Song 2 , Mitzi Gonzales 1 , Sara Espinoza 3 , Carlos Jaen 1 , Jing Wang 4 , and Kumar Sharma Type 2 diabetes (T2D) is a major risk factor for functional decline in older adults.Mobile/wearable devices are evidenced to improve lifestyles for diabetes management and improve functionality.This study assessed the associations of technology tracked lifestyle and self-monitoring behaviors with glycemic control, physical function and mitochondrial function related metabolites in older adults with T2D.Fitbit fitness trackers were used to track physical activity and food intake over 12-week in 15 older adults with T2D (age=70.5±4.8).Physical function was assessed by Short Physical Performance Battery (SPPB) and grip strength.First void urine was used to assess metabolites.The associations of percentage of days with tracked steps (PDWTS), percentage of days with food log (PDWFL), and 7-day mean steps with HbA1c, SPPB, grip strength and metabolites were examined using Pearson Correlation analysis.At week 12, PDWTS was negatively associated with 3-Hydroxyisovaleric acid and Hydroxyhippuric acid (P< 0.05).PDWFL was negatively associated with HbA1c, Hydroxyisovaleric acid, Hydroxyhippuric acid, and Hydroxybutyric acid (p< 0.05); SPPB was not related to any self-monitoring and lifestyle behaviors, but was negatively related to Hydroxyisovaleric acid, Glycolic acid and Hydroxyisobutyric acid (p< 0.05).
In older adults with T2D, self-monitoring might improve glycemic control.Self-monitoring and SPPB were related to several urine metabolites, but the underlying mechanisms is unclear in this study with small sample size.Future research with sufficient power is needed to investigate the underlying mechanisms of self-monitoring and lifestyle behaviors on these metabolites, and how these metabolites might be applied to improve physical function in older adults with T2D.

USING HOSPITAL ELECTRONIC HEALTH RECORDS TO DETERMINE FRAILTY WITH THE PICTORIAL FIT-FRAIL SCALE
Alanna Bohnsack 1 , Karla Faig 1 , Allyson Cook 2 , Cameron MacLellan 2 , Susan Benjamin 3 , Josh Shanks 2 , Sherry Gionet 1 , and Pamela Jarrett 1 , 1. Horizon Health Network,Saint John,New Brunswick,Canada,2. Dalhousie University,Saint John,New Brunswick,Canada,3. Trauma New Brunswick,Saint John,New Brunswick,Canada Hip fractures are common in older adults, particularly those that are frail.There is no "gold standard" tool to measure frailty retrospectively from hospital Electronic Health Records (EHRs).The aim of this research was to explore the utility of the Pictorial Fit-Frail Scale (PFFS) in determining frailty retrospectively in older adults admitted to hospital with a hip fracture.A random sample of 200 patients who had a hip fracture was extracted from a larger sample of 682 hip fractures that occurred in older adults (65 years and older) admitted to a Level 1 Trauma Center (April 2015-March 2019).Each EHR was reviewed to determine the availability of data and the score for each of the 14 PFFS domains.The majority, 189 (94.5%) of the EHRs, had data to complete 11-14 of the domains.Patient information was often unavailable to complete the domains of daytime tiredness and pain.The average age was 83.2 (SD 8.2), and 73.0% were female.The mean Raw PFFS score prior to admission was 9.7 (SD 6.6), and 45.5% of patients were classified as moderately or severely frail.Using the Standardized PFFS score (adjusted for up to three missing domains), the mean score was 11.8 (SD 7.9), and 58.2% of patients were classified as moderately or severely frail.The hospital EHR can be used to complete the PFFS.This finding provides researchers and healthcare professionals with a way to stratify older hospitalized patients by frailty, which may be a useful tool for evaluating health outcomes.